C L E A R L Y
Diabetic macular edema
Patient Information Leaflet: Diabetic Macular Oedema
Your Guide to Understanding Causes, Symptoms, and Treatment
What Is Diabetic Macular Oedema (DME)?
Diabetic macular edema (DME) is a serious eye disease that can have a devastating effect on vision in people with diabetes.
DME occurs because prolonged high blood sugar harms the tiny blood vessels in the retina and causes fluid to leak into the macula (the central part of the retina responsible for sharp, detailed vision). The macula becomes swollen, making activities such as reading, driving, and even recognizing faces increasingly difficult.
DME can occur at any stage of diabetic retinopathy or diabetic eye disease. In fact, DME can occur even before there are other signs of diabetic eye disease. Educating yourself about diabetes and its complications is critical because early detection leads to treatment that can significantly minimize permanent vision loss while helping a person maintain their independence and quality of life.
Prevalence and Risk Factors: The Global & Local Burden
DME is one of the leading causes of vision impairment in people with diabetes worldwide. Research shows that roughly 5.5% of people with diabetes globally are affected by this condition.
Statistics: India and the UK
| Country | Key Statistics | Importance |
| India | India is home to an estimated 77 million adults with diabetes (2019 figures), a number predicted to rise significantly. In one study of an urban South Indian population, the prevalence of DME was reported to be around 13.83% (3.03% center-involving and 10.80% non-center involving). | Due to the vast number of people with diabetes, the absolute number of DME cases is significant, making it an urgent public health challenge and an emerging leading cause of vision impairment in working adults in urban areas. |
| United Kingdom (UK) | DME affects approximately 7.12% of people with diabetes in England, representing over 166,000 individuals (based on 2010 estimates). The UK’s comprehensive NHS Diabetic Eye Screening Programme has resulted in sight-threatening diabetic retinopathy (and thus DME) being no longer the most common cause of blindness in the working age group. | The success of the UK’s systematic screening shows that timely, annual monitoring and treatment are essential to prevent severe, irreversible vision loss. |
Risk Factors (The Likelihood of DME Rises With):
• Uncontrolled blood sugar (high HbA1c levels)
• High blood pressure (Hypertension)
• High cholesterol (Hyperlipidemia)
• Long-standing diabetes (especially over 10-15 years)
• Pregnancy in women with pre-existing diabetes
• Lifestyle factors such as smoking, poor diet, and lack of exercise.
Symptoms to Watch For
DME often develops gradually, and symptoms may be subtle at first. Since the early stages may be symptom-free, annual eye examinations for people with diabetes are essential.
As the condition progresses, individuals may notice:
• Blurred or fluctuating vision
• Difficulty seeing fine details, especially while reading
• Dark or empty areas in the central vision
• Colors appear faded or washed out
• Occasional sudden vision loss in more severe cases
Diagnosis and Monitoring
At our clinic, we use advanced imaging techniques to diagnose and monitor DME. These tools help specialists detect even subtle changes in the retina, allowing treatment to begin at the optimal stage.
• Optical Coherence Tomography (OCT): Creates detailed cross-sectional images of the retina to detect swelling or fluid accumulation. (This is the main diagnostic tool)
• Fluorescein Angiography: Uses a special dye to highlight retinal blood vessels and identify leaks or blockages.
• Fundus Photography: Captures high-resolution images of the retina for tracking changes over time.
Treatment Options
Although there is no permanent cure for DME, effective treatments can slow disease progression and preserve vision. Treatment choice depends on disease severity, patient-specific factors, and overall eye health. Early intervention consistently leads to better outcomes and may prevent further deterioration.
| Treatment Type | How It Works |
| Anti-VEGF Injections | These injections block a protein (Vascular Endothelial Growth Factor) that causes abnormal blood vessels to grow and leak, directly reducing macula swelling. (First-line treatment in many cases) |
| Steroid Injections | These reduce inflammation and help control fluid accumulation in the macula. They are often used when Anti-VEGF injections are less effective. |
| Laser Therapy | In some cases, a highly precise laser is used to seal leaking blood vessels to prevent further fluid leakage and damage. |
| Vitrectomy Surgery | In advanced cases, surgery is performed to remove blood, scar tissue, or other obstructions (like a tractional membrane) from the retina. |
The following is a list of the most common anti-VEGF injections used to treat Diabetic Macular Oedema (DMO/DME).
Anti-VEGF (Vascular Endothelial Growth Factor) drugs work by blocking a protein that causes abnormal blood vessels to grow and leak fluid into the macula, which is what causes the swelling.
| Generic Name | Brand Name(s) | Key Information |
| Aflibercept (2mg) | Eylea® | An FDA-approved first-line treatment for DME. |
| Aflibercept (8mg) | Eylea HD® | A higher-strength version of aflibercept approved for DME, which may allow for longer intervals between injections for some patients (up to 3 or 4 months, and potentially longer). |
| Ranibizumab | Lucentis® | An FDA-approved first-line treatment for DME. |
| Faricimab | Vabysmo® | A newer FDA-approved treatment that targets both VEGF and Angiopoietin-2, potentially allowing for extended dosing intervals. |
| Bevacizumab | Avastin® | Used “off-label” for DME (meaning it’s not specifically approved for eye conditions but is commonly and safely used by ophthalmologists). |
| Brolucizumab | Beovu® | An anti-VEGF drug sometimes used for DME. |
Key Points for Living with Diabetic Macular Oedema
Managing DME requires a combination of medical care, lifestyle adjustments, and ongoing monitoring. Our clinic provides personalized care focused on your long-term independence.
Top 5 Bold Points to Remember
1. NEVER miss your annual eye screening. DME often has no symptoms in the early, treatable stages.
2. Strictly control your blood sugar (HbA1c) to stop the progression of retinal damage.
3. Manage your blood pressure and cholesterol; these are critical co-factors that accelerate eye damage.
4. Adhere to your injection schedule (Anti-VEGF or steroid); delaying treatment can cause irreversible vision loss.
5. Stop smoking immediately. Smoking drastically increases your risk of severe complications.
Bibliography/References
1. World Health Organization (WHO) Global Data on Diabetes and its Complications. (General DME prevalence).
2. Yau, J. W. Y., et al. (2012). Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. (Global DR statistics).
3. Harding, S. P., et al. (2011). Prevalence of diabetic macular oedema and related health and social care resource use in England. British Journal of Ophthalmology. (UK/England statistics).
4. Pradhana, V., et al. (2022). Optical Coherence Tomography-Based Prevalence of Diabetic Macular Edema and its Associated Risk Factors in Urban South India. Ophthalmic Epidemiology. (India regional prevalence statistics).
5. International Diabetes Federation (IDF). (2019). Diabetes Atlas. (India diabetes population statistics).
6. The Royal College of Ophthalmologists (RCOphth). UK Diabetic Retinopathy Screening Programme Guidelines. (UK treatment success reference).